Why America Needs Medicare for All

It’s the only way to achieve universal, affordable and high-quality health insurance.

By Meagan Day and Bhaskar Sunkara

Ms. Day is a staff writer at Jacobin, where Mr. Sunkara is editor.

Aug. 10, 2018

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Senator Bernie Sanders spoke about Medicare for All during a September health care rally in California.CreditJustin Sullivan/Getty Images North America

A growing majority of Americans agree: Health care shouldn’t be a business. They’re finally coming around to the idea that it can and should be a public good instead — something we can all turn to when the need arises.

The favorite right-wing argument against Medicare for All — the most popular approach to universal, publicly financed heath care — is that it’s too expensive. More on those costs in a moment. But first, we should note that our current health care system is actually the most expensive in the world by a long shot, even though we have millions of uninsured and underinsured people and lackluster health outcomes.

This is partly because a lot of that money doesn’t go directly toward keeping people healthy. Instead it goes to the overhead costs required to keep businesses running. These include exorbitant executive salaries, marketing to beat out the competition, the labor-intensive work of assessing and denying claims and so on. None of these would be a factor in a single-payer, Medicare for All system. Taiwan and Canada both have single-payer systems, and both spend less than 2 percent of total expenditures on administrative costs — and so does the United States’s current Medicare program. By contrast, private insurers in the United States spend as much as 25 percent on overheads.

But the most important way Medicare for All would save money isn’t by slashing administrative costs. It’s by using the power and size of the government, like other countries around the world currently do, to negotiate favorable terms with drug companies and service providers. There’s a reasona CT scan costs $896 in the United States, but only $97 in Canada.

And what about the sticker shock factor — the dramatic rise in government spending to accommodate such a program? Medicare for All would transfer all payment responsibility to one public agency (as opposed to a bunch of private companies), and that act of combination produces the big price tag that conservatives use as a cudgel. But while this would be more expensive for the government, it wouldn’t be for ordinary Americans. The money would be raised through progressive income and corporate taxes and end up costing most people less than their current health care. And coverage would be comprehensive and universal, meaning nobody would ever be unable to afford the care they need.

Pursuing Medicare for All would come with its own set of dilemmas: Eliminating an entire industry won’t be easy, and we’ll face plenty of political resistance and calls for half-measures. But if we want actual universal coverage, and we want it to be affordable and high-quality, Medicare for All is the only way forward.

This is our fifth and last newsletter; next week Quinta Jurecic of Lawfare will substitute for David Leonhardt. We’ll leave you with a few suggestions for further reading:

This article is part of the Opinion Today newsletter. David Leonhardt, the newsletter’s author, is on a break until Aug. 27. While he’s gone, several outside writers are taking his place. This week’s authors are Meagan Day, a writer for the socialist magazine Jacobin, and Bhaskar Sunkara, the magazine’s editor. You can sign up here to receive the newsletter each weekday.

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